Bioethical Concerns During the COVID-19 Pandemic: What Did Healthcare Ethics Committees and Institutions State in Spain?.
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2021
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Frontiers in Public Health
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Abstract
Objectives: Each new wave of the COVID-19 pandemic invites the possible obligation
to prioritize individuals’ access to vital resources, and thereby leads to unresolved and
important bioethical concerns. Governments have to make decisions to protect access
to the health system with equity. The prioritization criteria during a pandemic are both a
clinical and legal-administrative decision with ethical repercussion.We aim to analyse the
prioritization protocols used in Spain during the pandemic which, in many cases, have
not been updated.
Method: We carried out a narrative review of 27 protocols of prioritization proposed
by healthcare ethics committees, scientific societies and institutions in Spain for this
study. The review evaluated shared aspects and unique differences and proffered a
bioethical reflection.
Results: The research questions explored patient prioritization, the criteria applied and
the relative weight assigned to each criterion. There was a need to use several indicators,
being morbidity and mortality scales the most commonly used, followed by facets
pertaining to disease severity and functional status. Although age was initially considered
in some protocols, it cannot be the sole criterion used when assigning care resources.
Conclusions: In COVID-19 pandemic there is a need for a unified set of criteria
that guarantees equity and transparency in decision-making processes. Establishing
treatment indications is not the aim of such criteria, but instead prioritizing access to care
resources. In protocols of prioritization, the principle of efficiency must vary according to
the principle of equity and the criteria used to guarantee such equity.
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Keywords
Equity, Morbidity, Mortality, Prioritization, Triage, Healthcare ethics committees, COVID-19